Provider Demographics
NPI:1346012598
Name:WU, JOSEPH SONG-EN (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SONG-EN
Last Name:WU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 E COUNTRYSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1024
Mailing Address - Country:US
Mailing Address - Phone:630-553-7073
Mailing Address - Fax:
Practice Address - Street 1:302 E COUNTRYSIDE PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1024
Practice Address - Country:US
Practice Address - Phone:630-553-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.034667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist